PMID- 18667139
OWN - NLM
STAT- MEDLINE
DCOM- 20090513
LR  - 20181201
IS  - 1533-7294 (Electronic)
IS  - 0094-3509 (Linking)
VI  - 56
IP  - 8 Suppl Hot Topics
DP  - 2007 Aug
TI  - Initiating insulin in patients with type 2 diabetes.
PG  - S12-20
AB  - Overall, 7% of the US population has type 2 diabetes mellitus (T2DM), and among 
      people aged 60 years or older, approximately 20% have T2DM, representing a 
      significant health burden in this age group. Furthermore, the incidence of T2DM 
      is increasing as the obesity epidemic increases and more patients are presenting 
      with T2DM at a younger age. Insulin resistance, which is characterized by 
      impaired glucose tolerance, begins years before the onset of T2DM. In response to 
      impaired glucose tolerance, beta-cell function initially increases (manifested as 
      hyperinsulinemia) to compensate for the increased insulin resistance. 
      Subsequently, a progressive loss of first-phase insulin response occurs, which is 
      manifested by progressively increasing postprandial glucose (PPG) levels. Fasting 
      plasma glucose (FPG) levels eventually rise above 126 mg/dL, a level defined as 
      clinical diabetes. As T2DM progresses, beta-cell function deteriorates further 
      and the patient requires progressively more aggressive therapeutic interventions 
      to achieve glycemic control. It is important for family physicians (FPs) to 
      convey this concept of disease progression to patients at the time of diagnosis. 
      Patients should understand that although they can slow disease progression with 
      long-term lifestyle modifications, they will eventually need to change or add 
      medications as the function of the pancreas continues to decline. FPs should also 
      emphasize that disease progression can be limited but not stopped, and thus, 
      patients should not blame themselves, particularly when they follow management 
      recommendations.
FAU - Aoki, Thomas J
AU  - Aoki TJ
AD  - University of California, Davis Health System, Davis, CA; Aoki Diabetes Research 
      Institute, Sacramento, CA USA.
FAU - White, Russell D
AU  - White RD
LA  - eng
PT  - Case Reports
PT  - Journal Article
PT  - Review
PL  - United States
TA  - J Fam Pract
JT  - The Journal of family practice
JID - 7502590
RN  - 0 (Blood Glucose)
RN  - 0 (Hypoglycemic Agents)
RN  - 0 (Insulin)
RN  - 0 (Thiazolidinediones)
RN  - 0 (Triglycerides)
RN  - 9034-51-9 (Hemoglobin A)
RN  - 9100L32L2N (Metformin)
RN  - 97C5T2UQ7J (Cholesterol)
RN  - X4OV71U42S (Pioglitazone)
SB  - IM
MH  - Blood Glucose/metabolism
MH  - Cholesterol/blood
MH  - Comorbidity
MH  - Diabetes Mellitus, Type 2/blood/*drug therapy/epidemiology
MH  - Drug Monitoring/methods
MH  - Drug Therapy, Combination
MH  - Family Practice/methods/standards
MH  - Female
MH  - Hemoglobin A/metabolism
MH  - Humans
MH  - Hyperglycemia/prevention & control
MH  - Hyperlipidemias/epidemiology/prevention & control
MH  - Hypertension/epidemiology/prevention & control
MH  - Hypoglycemic Agents/*administration & dosage
MH  - Insulin/*administration & dosage
MH  - Metformin/therapeutic use
MH  - Middle Aged
MH  - Pioglitazone
MH  - Practice Guidelines as Topic
MH  - Randomized Controlled Trials as Topic
MH  - Thiazolidinediones/therapeutic use
MH  - Treatment Outcome
MH  - Triglycerides/blood
RF  - 40
EDAT- 2007/08/01 00:00
MHDA- 2007/08/01 00:01
CRDT- 2007/08/01 00:00
PHST- 2007/08/01 00:00 [pubmed]
PHST- 2007/08/01 00:01 [medline]
PHST- 2007/08/01 00:00 [entrez]
AID - jfp_5608n [pii]
PST - ppublish
SO  - J Fam Pract. 2007 Aug;56(8 Suppl Hot Topics):S12-20.